Longevity and Reilgion/Spirituality

A rare study--where a group of individuals born in 1920s were followed over several decades looking at their spiritual beliefs--reported that significant increase in spirituality was evident from late middle age (mid-50s to late 60s) to older adulthood (late 60s to mid-70s). This was irrespective of gender. Similar snapshots of people's beliefs have been substantiated by survey research and public opinion polls since the 1930s. The consistent finding is that older means that you are likely to become more religious/spiritual.

Because aging is correlated with spirituality it is not surprising to find that spiritual people are older and that older people are spiritual. Aging is correlated with spirituality. Spirituality does not, by itself, confer increased longevity. Being spiritual or religious is not a good predictor of how old you will live to, although it might tell us how old you are now. This is despite anecdotal “secrets” for longevity that people older than 85 years, gave for their good health and long life, which were "faith in God" and "Christian living." All valid responses but perhaps not accurate in this diverse society of today.

Allison Sullivan from the University of Pennsylvania published a study in 2011 showing that Jews have lower mortality than the rest of the USA. All other religions were comparable or, as with Black Protestants, had a life expectancy as much as five years lower than the average US citizen. So religion by itself is not a good predictor. 

Religious affiliation follows other variables. For example, those that reported being Jewish reported lowest prevalence of drinking alcohol, were mainly women (comparable only to Catholics), were nearly exclusively White, and were the richest by a very wide margin. These are all factors that by themselves, regardless of their religious affiliation, promotes higher life expectancy. Religion and spirituality, by themselves, are not very good predictors of long life. Where religion and spirituality show distinct advantage is in coping with imminent death. 

In an Australian study, which conducted detailed interviews of older adults in nursing homes and independent living homes, it was reported that religious older adults reframe memories and experiences linked with final meanings, transcend their losses and suffering, reported intimacy with God and others, and found hope. God for them was the ultimate consolidator.

Reporting religious beliefs is also associated with how your caregivers treat you. Nursing assistants who held similar beliefs as their elderly long-term clients, expressed more meaningful connections with them which resulted in better care. Which brings up the issue of what happens when societies are becoming more diverse both in terms of culture and religion and also in term of sexual preferences?

Spirituality does not confer longevity although having meaning in life does--not necessarily spiritual. Especially if you compare people’s religious participation with other older adults participating in other social events, the difference in longevity between religious and non-religious participants disappears. Being religious by itself does not promote longevity, but it might help how you are treated should you lose your independence.

Depression without Sadness

Depression is a seriously debilitating disease that increases your chances of early death. In a report that looked at twenty five separate research studies the conclusion was that depressed people are nearly twice as likely to die early when compared to non-depressed people.

Depression affects about fifteen in every hundred older adults. There seems to be less of a difference between gender than at younger ages and affects different ethnicities equally. Although these studies find that depression is less common in older age, it might be argued that we are not measuring depression correctly among older adults.

An emerging argument is that depression in older adults is more subtle and remains undetected. While on the other hand depressive symptom checklists are inflated as they include symptoms that are directly linked to a physical illness or bereavement, both of which increase in frequency with age. How good are we at identifying depression among older adults?

Although we normally associate depression with sadness, studies are now showing that older adults are generally less likely than young adults to report sadness--dysphoria--when they are depressed. Joseph Gallo from John Hopkins University and colleagues reported that in a number of different studies older adults were less likely to report being sad than younger persons.  And this seems to be an aging effect rather than to a particular generation. People who might have expressed sadness with depression when they were young, as they get older they are less likely to express sadness with their depression. Depression among older adults is related more to listlessness and lack of interest in life rather than sadness.

It could be that older adults are better at separating sadness from depression. However studies show that older adults are not very good at identifying facial expressions showing anger, fear, happiness, and sadness. And it is the more subtle expressions of emotions that older adults have trouble with.  Andrew Mienaltowski and his colleagues in Bowling Green, Kentucky show that in general, older adults have more difficulty discriminating between low intensity expressions of negative emotions than did younger adults.

The issue is that older adults not only do not express sadness with their depression but that they are less likely to see sadness in others. With health care professionals getting older, it is not just depressed older adults that we need to be concerned about but also their physicians. If older physicians are less likely to see sadness then they are less likely to notice depression. Depression without sadness is not only difficult to detect by physicians it is also a silent killer. In a 13-year follow-up, older adults who reported  depressive symptoms without dysphoria--nondysphoric depression--were at increased risk for death, functional limitation, cognitive impairment and psychological distress. Among suicide victims 55 and older, 58 percent visited a general physician in the month before the suicide. In fact, 20 percent see a general physician on the same day and 40 percent within one week of the suicide.

Depression among older adults is a serious issue and it is not part of the aging process. The lack of expression of sadness and the diminished ability by others of perceiving sadness further hides this silent early killer.

Painful Religion at End-Of-Life

In the United States nearly eight out of every ten hospital deaths have no formal pain management. More than eight out of every ten older long-term care facility residents experienced untreated or under-treated pain at the time of death. While seven out of ten people on Medicare who are dying, regardless of their age or where they died, received inadequate amount of pain management. People in the United States are dying in pain.

Most Americans--three of every four--do not fear death as much as we fear being in pain at the time of death. Despite these clearly stated and seemingly universal preferences, too many of the 3 million Americans who die in health care settings each year suffer needlessly in pain at the end of life.

Persons dying from prolonged illnesses can, and should, experience a “good death”. And we know exactly what that means. For most of us a good death consists of dying at home, surrounded by family, and free from pain and suffering. And our preference to die in such a dignified manner is consistent regardless of one’s age, gender, ethnicity, or religious background.

However, by following Christian and Protestant fundamentalist beliefs people who are dying are less likely to have access and select methods for hastening the process of dying. In the United States, approximately 25% of all U.S. deaths occur in the long-term care setting, and this figure is projected to rise to 40% by the year 2040.

The belief in an afterlife--and the support from caregivers who share the same belief--must contribute to the fact that being religious is negatively associated with fear of death.  But there is also the worry that some religious beliefs, because of their emphasis on natural death, preclude you from pain medication that might hasten death and taking control over what for most of us will be a painful final passage through life.

Although religious doctors were significantly less likely than their non-religious colleagues to provide treatment with at least some intent to shorten life, when religious doctors did provide such treatment they were significantly less likely to have discussed this with their patient. And this is the unspoken secret of hospitals.

Physicians prescribe pain medication that hastens the final passage of death in a clandestine manner. We live (or die) in an atmosphere of silent favors to alleviate pain.

The Universal Declaration of Human Rights: Article 5 “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” The renowned physician Jack Kevorkian’s final push to bring this issue to the Supreme Court--where it should be legitimately decided and which they arrogantly refused to hear—only resulted in pushing him into jail. Because  of religious self-censoring we are not approaching the issues head-on. We are therefore resigned to repeating the same mistakes. Older adults in the United States will continue to die in pain.

As Susan Imhof and Brian Kaskie have argued,  “we can only conclude that public policies will fall even further behind the advancement of evidence-based pain-policy guidelines, and the number of Americans who continue to suffer needlessly in pain at the time of death will only increase.”

© USA Copyrighted 2013 Mario D. Garrett
In memory of Uncle Freddie who died after a protracted illness.

Last Will and Testament

Legacy: an enduring gift after death. It has often been the vision of humans to become immortal. Apart from science fiction, the reality is that the only way to become immortal is to leave something behind that endures--in what the philosopher Karl Popper referred to as  “World 3.”  These are items that are shared in the world after we are gone: articles, prose, paintings, music, inventions, buildings, policies, social transformations. For all others that have not had a chance for such Popperian creativity,  there is the last will and testament to ensure that after their death, their estate is left to those that they choose.

But sometimes, people have left some weird and wonderful requests. The notoriety of these requests are perhaps more of a legacy than the distribution of the wealth itself. One such area of puzzlement has been the bequeathing of large sums of monies to dogs and cats.

Leona Helmsley the "Queen of Mean" established a $12 million trust to her Maltese dog while leaving $5 million each to her grandsons. Meanwhile Eleanor Ritchey, enriched by the Quaker Oil State Refining Corporation business, left about $14 million to her 150 stray dogs. A California prune rancher Thomas Shewbridge's left all shareholder rights of his estate to his two dogs, who regularly attended stockholders' and board of directors' meetings. The British singer Dusty Springfield left instructions stipulating that her cat was to be fed imported baby food and serenaded with Springfield's songs. Increasing the cat's romantic ambience by also arranging for the cat to marry his new guardian's pet cat. While Doris Duke heiress of the American Tobacco Company—and founding of Duke University--stated that $100 million was to be secured in a pet trust for her dogs.

While some final instructions are not ultimately upheld in a court of law, they have redefined our meaning of legacy. Perhaps there is a deeper message. One impression from these last wills and testaments is how inconsequential money is and that the best way to transmit this message is by giving it away to pets that do not understand its value. Perhaps there are better ways of transmitting such a message. But is there a better way?

In 2005, a study by Allianz found that leaving a legacy (an emotional inheritance) was far more important to peoples than leaving an inheritance, and that 77% of both “baby boomers” and their parents rated “values and life lessons” as the most important legacy they could receive or leave. Would it be better to write an "ethical" will? A parent’s insight, knowledge and wisdom to transfer to younger generations.

The importance of writing down one's innermost concerns is demonstrated in an old study--which has been repeated many times since--by James Pennebaker from the University of Texas. He found that when people--who had experienced significant trauma--wrote about their experience, they showed positive effects on blood markers of immune functions, and that this continued for six weeks.
Ethical wills are valued by the recipient as well as being beneficial to the writer.

We need to include ethical wills as part of Popper's World 3. What better way to leave the world but to transmit the knowledge that you have gained so that future generations can stand on your insights and reach higher ideals. For most of us, that is all we have to transmit, and it might not be such a poor option.

Gerontocracy, Plutocracy, Oligarchy and the Aging Revolution

The 111th Congress, which took office in 2009, was the oldest in USA history. While the average age in the Senate was 59 in 1945, it was 63 in 2011. Similarly with the Senate, the average age of representatives at the House rose from 53 in 1945 to 57 in 2011. Although the 112th Congress was slightly younger by a few months, the trend is unmistakable. We have a pattern where the average American is more than 20 years younger than the person who represents him or her in Congress.

When the novelist Richard K. Morgan wrote the Takeshi Kovacs series, he imagined a world in the 25th century where an incredibly wealthy elite rules the world. Although this is the situation today, the difference is that the series of novels envisaged a technology so advanced that it granted these wealthy rulers effective immortality and unfathomable wisdom through the ability to transfer the accumulated knowledge  of human minds. These individuals are known as "Meths". Referring to Methuselah the longevity icon from the bible. A world that is governed by a combination of gerontocracy (ruled by older adults), oligarchy (ruled by a few) and plutocracy (ruled by the wealthy.)

In The Republic, Plato wrote: “it is for the elder man to rule and for the younger to submit”. The sensationalism is lost when we realize that this has been the trend since the inceptions of societies--with minor but significant exceptions.  While the ancient Greek city state of Sparta was ruled by a flat out gerousia--a council made up of members who had to be at least 60 years old and who served for life, most variants of gerontocracy are less prescriptive. In addition, all theocratic states and organizations--in which leadership is concentrated in the hands of religious elders--are traditional gerontocracies, as with the Holy See, Islamic State and Mormonism among others. And as we have seen, our Congress is becoming increasingly gerontocratic.

Although traditionally it was assumed that some skills—for example, mathematics--drastically decline with age, political life was observed to nurture older adults. However, a new study in 2012  of British civil servants by the French epidemiologist Archana Singh-Manoux shattered this conception. The study shows that cognitive skills such as memory and reasoning start declining as early as 45. Except for vocabulary. Political spin it seems remains a forte of gerontocracy.

Such age-related decline is detrimental. But with increasing age of politicians comes other more serious diminishment that sometimes accompanies older adults. Ron Reagan contends that his father, President Ronald Reagan, showed signs of Alzheimer's disease three years into his first term. President Reagan went on to serve two 4-year terms in office.

The greatest of Roman orators, Marcus Tullius Cicero, had some insights: "Nothing is so unbelievable that oratory cannot make it acceptable." The "great communicator"--as President Reagan was known--might increasingly be the way of emerging gerontocracies. Where the power of oration trumps a prudent government. Cicero again had this to say ” The budget should be balanced, the treasury should be refilled, public debt should be reduced, the arrogance of officialdom should be tempered and controlled…”

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

Geography of Aging

If aging occurred as a random event, unaffected by external variables, the distribution of older adults would be equal across geography regardless of what individuals do or how they live.  But we do not see that.

Instead, what we find are distinct clusters of older adults. Wealthy countries have proportionally more older adults than poor countries, Blacks and minority groups have lower percentages of adults living to older ages.  Educational levels and income increase longevity, long-lived parents have long-lived children, happy healthy people live longer, obese people die earlier.  Taller people die earlier, women who give birth later in life live longer and have longer-lived children, long-lived people escape diseases, and women outlive men.

Michelle Poulain a demographer who identified the "Blue Zones" while marking communities of centenarians on a map with his blue pen, has come up with a number of clusters. And they are all related to geography. The only clusters of extreme long-lived older adults are found in natural environments in traditional cultures within a confined geography. These "Blue Zones" are places of exceptional longevity.

Recent advances in genetic manipulation in animals which increases life expectancy by 30 to 50 percent is overshadowing studies of geography that show similar improvements in life expectancy of similar magnitude.

Where we live is just as important in promoting longevity as biological manipulations. For example some Black inmates in prison live longer than their peers living in the community. Our environment can protect us from harm, but can it also promote health?  Numerous studies have shown that both monks and nuns living in religious orders live much longer by a margin of 11 to 31 percent. And we all live in segregated communities. 

Rich people live in rich neighborhoods and poor people live in poor neighborhoods. And it seems that being in a place where we belong promotes health. Researchers found that low-income older adults living in high-income neighborhoods had poorer physical functioning, more functional limitations, worse self-rated health, worse cognitive ability, and were lonelier than low-income adults who lived in low-income neighborhoods. Being in a high-income neighborhood did not confer an advantage because they did not belong.

The process whereby the feeling of belonging is translated into a longer life is turning out to be simple. Researchers are exposing the role of how genes have a capacity to switch on and off according to the internal environment in our bodies. Epi-genes, as they are known, can be switched on and off, allowing for the expression or suppression of our genetic information. 

The environment can trigger epigenetic changes. In addition,  how we feel about our community changes our internal chemicals which affect our epigenetic makeup. How we feel about where we live changes how our body expresses our genes.

Which might explain why it is that the only clusters of extreme long-lived older adults are found in natural environments in traditional cultures within a community that they belong to. The feeling of belonging translates into our bodies being contented and not ready to shut down. If we understood the body better we would not need to know the brain.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com